| NPI | 1841592110 |
|---|---|
| Doing Business As | WALLACE |
| Other Name | WALLACE MEDICAL CONCERN |
| Entity Type | Organization |
| Authorized Contact | LISA A. CLINE Chief Executive Officer 503-489-1760 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 122300000X Dentist |
| 124Q00000X Dental Hygienist | |
| 207Q00000X Family Medicine | |
| 261QC1500X Clinic/Center, Community Health | |
| 261QD0000X Clinic/Center, Dental | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LP0808X Nurse Practitioner, Psych/Mental Health | |
| Enumeration Date | 2010-11-18 |
| Last Update Date | 2022-02-24 |